早期急性白血病与类风湿性关节炎的鉴别诊断探讨

骨关节肌肉症状是许多小儿急性白血病（AL）的早期表现，有可能误诊为类风湿性关节炎（RA）。本文比较了误诊为RA的AL患儿与RA患儿的早期和确诊时的临床和实验室表现，发现AL组骨关节肌肉疼痛剧烈，关节不肿或轻微肿大，常为短暂性，胸骨压痛常见，RA组关节固定性持续肿大，单纯胸骨压痛罕见。AL组Hb的下降速度快，幅度大也与RA组有别；血小板减少和持续下降有利于AL的诊断，RA组则正常和增加而无下降。强调有经验的临床病理学家和血液学家多次观察血涂片的细胞形态非常重要，若有可疑，应即时作骨髓检查。特别指出使用电子血球计数仅而不作细胞形态学观察，有可能贻误诊断。

DIFFERENTIATION BETWEEN INITIAL ACUTE LEUKEMIA AND RHEUMATOID ARTHRITIS

In many acute leukemia patients, skeletal, articular, and muscular symptoms are the initial manifestations which minic rheumatic diseases, and may be erroniously diagnosed as rheumatoid arthritis. We compared the clinical and hematological manifestations between acute leukemia patients and rheumatoid arthritis patients both near the onset and after the diagnosis of the diseases. It revealed that in acute leukemia, bone, joint, and muscle pain may be sever, but joint swelling may be slight, transient, or nonexist, sternum tenderness has been always detected. In rheumatoid arthritis, joint swelling persist, sternum tenderness rare. The speed and rage of hemoglobin decrease are higher in acute leukemia than rheumatoid arthritis. Thrombocytopenia or thrombocytes progreesively decrease are favour of the diagnosis of acute leukemia, thrombocytes are always normal or increased in rheumatoid arthritis. The study of the blood smear by the experienced clinical pathologist and hematologist is extremely importent to detect abnormal cells, the electronic counter can't replace the observation of the blood cell morphology.